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Ophthalmoplegic migraine.

Morris Levin1, Thomas N Ward

  • 1Section of Neurology, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA. Morris.Levin@hitchcock.org

Current Pain and Headache Reports
|July 2, 2004
PubMed
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Ophthalmoplegic migraine, now classified as neuralgia, presents with headache and temporary eye muscle paralysis. Research suggests it may be an inflammatory neuropathy rather than a migraine variant.

Area of Science:

  • Neurology
  • Ophthalmology
  • Neuroscience

Background:

  • Ophthalmoplegic migraine was previously considered a migraine variant.
  • Recent findings suggest it may be an inflammatory cranial neuropathy.
  • The International Headache Classification now categorizes it as neuralgia.

Purpose of the Study:

  • To discuss potential pathophysiological mechanisms of ophthalmoplegic migraine.
  • To review clinical presentation, diagnosis, and treatment of this rare condition.

Main Methods:

  • Review of clinical observations and magnetic resonance imaging findings.
  • Discussion of diagnostic challenges and differential diagnoses.
  • Analysis of proposed treatment strategies, including prophylactic medications and steroids.

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Main Results:

  • Ophthalmoplegic migraine typically involves headache and transient oculomotor nerve palsies (affecting eye movement, pupil, and eyelid).
  • It commonly affects children but also occurs in adults.
  • Prognosis is generally good with symptom resolution, though deficits can persist after multiple episodes.

Conclusions:

  • Ophthalmoplegic migraine is reclassified as neuralgia, likely representing an inflammatory neuropathy.
  • While prognosis is favorable, persistent deficits are possible.
  • Optimal treatment remains unclear, with proposed options including migraine prophylactics and steroids with variable efficacy.